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Chan JCN, Yang A, Chu N, Chow E. Current type 2 diabetes guidelines: Individualized treatment and how to make the most of metformin. Diabetes Obes Metab 2024. [PMID: 38992869 DOI: 10.1111/dom.15700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 07/13/2024]
Abstract
Evidence-based guidelines provide the premise for the delivery of quality care to preserve health and prevent disabilities and premature death. The systematic gathering of observational, mechanistic and experimental data contributes to the hierarchy of evidence used to guide clinical practice. In the field of diabetes, metformin was discovered more than 100 years ago, and with 60 years of clinical use, it has stood the test of time regarding its value in the prevention and management of type 2 diabetes. Although some guidelines have challenged the role of metformin as the first-line glucose-lowering drug, it is important to point out that the cardiovascular-renal protective effects of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists were gathered from patients with type 2 diabetes, the majority of whom were treated with metformin. Most national, regional and international guidelines recommend metformin as a foundation therapy with emphasis on avoidance of therapeutic inertia and early attainment of multiple treatment goals. Moreover, real-world evidence has confirmed the glucose-lowering and cardiovascular-renal benefits of metformin accompanied by an extremely low risk of lactic acidosis. In patients with type 2 diabetes and advanced chronic kidney disease (estimated glomerular filtration rate 15-30 mL/min/1.73m2), metformin discontinuation was associated with an increased risk of cardiovascular-renal events compared with metformin persistence. Meanwhile, it is understood that microbiota, nutrients and metformin can interact through the gut-brain-kidney axis to modulate homeostasis of bioactive molecules, systemic inflammation and energy metabolism. While these biological changes contribute to the multisystem effects of metformin, they may also explain the gastrointestinal side effects and vitamin B12 deficiency associated with metformin intolerance. By understanding the interactions between metformin, foods and microbiota, healthcare professionals are in a better position to optimize the use of metformin and mitigate potential side effects. The United Kingdom Prospective Diabetes Study and the Da Qing Diabetes Prevention Program commenced 40 years ago provided the first evidence that type 2 diabetes is preventable and treatable. To drive real-world impact from this evidence, payors, practitioners and planners need to co-design and implement an integrated, data-driven, metformin-based programme to detect people with undiagnosed diabetes and prediabetes (intermediate hyperglycaemia), notably impaired glucose tolerance, for early intervention. The systematic data collection will create real-world evidence to bring out the best of metformin and make healthcare sustainable, affordable and accessible.
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Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Natural Chu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Phase 1 Clinical Trial Centre, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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Peerawaranun P, Pan-Ngum W, Hantrakun V, Wild SH, Dunachie S, Chamnan P. Diabetes and risk of hospitalisation due to infection in northeastern Thailand: Retrospective cohort study using population-based healthcare service data. Diabet Med 2024:e15378. [PMID: 38853385 DOI: 10.1111/dme.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/05/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Population-based studies describing the association between diabetes and increased risk of infection have largely been based in high-income countries. There is limited information describing the burden of infectious disease attributable to diabetes in low and middle-income countries. This study aimed to describe the burden and risk of infectious disease hospitalisation in people with diabetes compared to those without diabetes in northeastern Thailand. METHODS In a retrospective cohort study using electronic health record data for 2012-2018 for 3.8 million people aged ≥20 years in northeastern Thailand, hospitalisation rates for any infectious diseases (ICD-10 codes A00-B99) were estimated and negative binomial regression used to estimate rate ratios (RR) for the association between diabetes and infectious disease hospitalisation adjusted for age, sex and area of residence. RESULTS In this study, 164,177 people had a diagnosis of diabetes mellitus at any point over the study period. Infectious disease hospitalisation rates per 1000 person-years (95%CI) were 71.8 (70.9, 72.8), 27.7 (27.1, 28.3) and 7.5 (7.5, 7.5) for people with prevalent diabetes, incident diabetes and those without diabetes respectively. Diabetes was associated with a 4.6-fold higher risk of infectious disease hospitalisation (RR (95% CI) 4.59 (4.52, 4.66)). RRs for infectious disease hospitalisation were 3.38 (3.29, 3.47) for people with diabetes managed by lifestyle alone and 5.29 (5.20, 5.39) for people receiving prescriptions for diabetes drugs. CONCLUSIONS In this Thai population, diabetes was associated with substantially increased risk of hospitalisation due to infectious diseases and people with diabetes who were on pharmacological treatment had a higher risk than those receiving lifestyle modification advice alone.
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Affiliation(s)
- Pimnara Peerawaranun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wirichada Pan-Ngum
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Viriya Hantrakun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Susanna Dunachie
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NDM Centre for Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Parinya Chamnan
- Cardiometabolic Research Group, Department of Social Medicine, Sunprasitthiprasong Regional Hospital, Ubonratchathani, Thailand
- College of Medicine and Public Health, Ubonratchathani University, Ubonratchathani, Thailand
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Hossain S, Rafi RH, Ripa FA, Khan MRI, Hosen ME, Molla MKI, Faruqe MO, Al-Bari MAA, Das S. Modulating the antibacterial effect of the existing antibiotics along with repurposing drug metformin. Arch Microbiol 2024; 206:190. [PMID: 38519821 DOI: 10.1007/s00203-024-03917-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
Owing to the extensive prevalence of resistant bacteria to numerous antibiotic classes, antimicrobial resistance (AMR) poses a well-known hazard to world health. As an alternate approach in the field of antimicrobial drug discovery, repurposing the available medications which are also called antibiotic resistance breakers has been pursued for the treatment of infections with antimicrobial resistance pathogens. In this study, we used Haloperidol, Metformin and Hydroxychloroquine as repurposing drugs in in vitro (Antibacterial Antibiotic Sensitivity Test and Minimum Inhibitory Concentration-MIC) and in vivo (Shigellosis in Swiss albino mice) tests in combination with traditional antibiotics (Oxytetracycline, Erythromycin, Doxycycline, Gentamicin, Ampicillin, Chloramphenicol, and Penicillin) against a group of AMR resistance bacteria (Bacillus cereus, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Shigella boydii). After observing the results of the conducted in vitro experiments we studied the effects of the above non antibiotic drugs in combination with the said antibiotics. As an repurposing adjuvant antibiotic drug, Metformin exhibited noteworthy activity in almost all in vitro, in vivo and in silico tests (Zone of inhibition for 30 to 43 mm for E.coli in combination with Doxycycline; MIC value decreased 50 µM to 0.781 µM with Doxycycline on S. boydii).In rodents Doxycycline and Metformin showed prominent against Shigellosis in White blood cell count (6.47 ± 0.152 thousand/mm3) and Erythrocyte sedimentation rate (10.5 ± 1.73 mm/hr). Our findings indicated that Metformin and Doxycycline combination has a crucial impact on Shigellosis. The molecular docking study was performed targeting the Acriflavine resistance protein B (AcrB) (PDB ID: 4CDI) and MexA protein (PDB ID: 6IOK) protein with Metformin (met8) drug which showed the highest binding energy with - 6.4 kcal/mol and - 5.5 kcal/mol respectively. Further, molecular dynamics simulation revealed that the docked complexes were relatively stable during the 100 ns simulation period. This study suggest Metformin and other experimented drugs can be used as adjuvants boost up antibiosis but further study is needed to find out the safety and efficacy of this non-antibiotic drug as potent antibiotic adjuvant.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Somlal Das
- University of Rajshahi, Rajshahi, 6205, Bangladesh
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Martin DE, Cadar AN, Bartley JM. Old drug, new tricks: the utility of metformin in infection and vaccination responses to influenza and SARS-CoV-2 in older adults. FRONTIERS IN AGING 2023; 4:1272336. [PMID: 37886013 PMCID: PMC10598609 DOI: 10.3389/fragi.2023.1272336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
In the face of global pathogens such as influenza (flu) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), strategies beyond standard vaccines and virus-specific treatments are critically needed for older populations who are more susceptible to severe disease and death from these infections due to age-related immune dysregulation. Thus, complimentary therapeutics are needed to address the increased risk of complications and death in older adults. Metformin, an FDA approved diabetes drug, is an attractive therapeutic candidate to improve immune defenses and resilience in older adults facing viral challenge. Metformin is already a candidate anti-aging drug, but its benefits have potential to span beyond this and improve specific immune responses. Metformin can target multiple aging hallmarks as well as directly impact innate and adaptive immune cell subsets. Both retrospective and prospective studies have demonstrated metformin's efficacy in improving outcomes after SARS-CoV-2 or flu infections. Moreover, evidence from clinical trials has also suggested that metformin treatment can improve vaccination responses. In totality, these findings suggest that metformin can improve age-related declines in immunological resilience. Strategies to improve outcomes after infection or improve vaccine-induced protection are invaluable for older adults. Moreover, the ability to repurpose an already FDA approved drug has significant advantages in terms of necessary time and resources. Thus, metformin has great potential as a therapeutic to improve age-related immune dysregulation during flu and SARS-CoV-2 infections and should be further explored to confirm its ability to improve overall immunological resilience in older adults.
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Wang W, Liu M, He Q, Wang M, Xu J, Li L, Li G, He L, Zou K, Sun X. Data source profile reporting by studies that use routinely collected health data to explore the effects of drug treatment. BMC Med Res Methodol 2023; 23:95. [PMID: 37081410 PMCID: PMC10120171 DOI: 10.1186/s12874-023-01922-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/13/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Routinely collected health data (RCD) are important resource for exploring drug treatment effects. Adequate reporting of data source profiles may increase the credibility of evidence generated from these data. This study conducted a systematic literature review to evaluate the reporting characteristics of databases used by RCD studies to explore the effects of drug treatment. METHODS Observational studies published in 2018 that used RCD to explore the effects of drug treatment were identified by searching PubMed. We categorized eligible reports into two groups by journal impact factor (IF), including the top 5 general medical journals (NEJM, Lancet, JAMA, BMJ and JAMA Internal Medicine) and the other journals. The reporting characteristics of the databases used were described and compared between the two groups and between studies citing and not citing database references. RESULTS A total of 222 studies were included, of which 53 (23.9%) reported that they applied data linkage, 202 (91.0%) reported the type of database, and 211 (95.0%) reported the coverage of the data source. Only 81 (36.5%) studies reported the timeframe of the database. Studies in high-impact journals were more likely to report that they applied data linkage (65.1% vs. 20.2%) and used electronic medical records (EMR) (73.7% vs. 30.0%) and national data sources (77.8% vs. 51.3%) than those published in other medical journals. There were 137/222 (61.7%) cited database references. Studies with database-specific citations had better reporting of the data sources and were more likely to publish in high-impact journals than those without (mean IF, 6.08 vs. 4.09). CONCLUSIONS Some deficits were found in the reporting quality of databases in studies that used RCD to explore the effects of drug treatment. Studies citing database-specific references may provide detailed information regarding data source characteristics. The adoption of reporting guidelines and education on their use is urgently needed to promote transparency by research groups.
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Affiliation(s)
- Wen Wang
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Mei Liu
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Qiao He
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Mingqi Wang
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Jiayue Xu
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Ling Li
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Guowei Li
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
- Biostatistics Unit, Research Institute at St. Joseph's Healthcare Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Lin He
- Intelligence Library Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Kang Zou
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China.
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China.
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Guo T, Sun X, Yang J, Yang L, Li M, Wang Y, Jiao H, Li G. Metformin reverse minocycline to inhibit minocycline-resistant Acinetobacter baumannii by destroy the outer membrane and enhance membrane potential in vitro. BMC Microbiol 2022; 22:215. [PMID: 36089583 PMCID: PMC9465895 DOI: 10.1186/s12866-022-02629-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Acinetobacter baumannii (A. baumannii) is an opportunistic pathogen and has emerged as one of the most troublesome pathogens. Drug resistance in A. baumannii has been reported on a global scale. Minocycline was found to be active against multi-drug resistant A. baumannii and was approved by the FDA for the infections caused by sensitive strains of A. baumannii. However, the emergence of minocycline resistance and its toxic effects still need to be addressed. Therefore, this study aimed to evaluate the synergistic effects of metformin combined with minocycline on minocycline-resistant A. baumannii. Results The effect of metformin on the antibacterial activity of minocycline was determined by checkerboard and time-killing assay. Further, it was observed by biofilm formation assay that metformin combination with minocycline can inhibit the formation of biofilm. Outer membrane integrity, membrane permeability, membrane potential and reactive oxygen species (ROS) were monitored to explore the underlying synergistic mechanisms of metformin on minocycline. And the results shown that metformin can destroy the outer membrane of A. baumannii, enhance its membrane potential, but does not affect the membrane permeability and ROS. Conclusion These findings suggested that the combination of metformin and minocycline has the potential for rejuvenating the activity of minocycline against minocycline-resistant A. baumannii.
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Wang W, Liu M, Xu J, Li L, Tan J, Guo JJ, Lu K, Li G, Sun X. Impact of time-varying exposure on estimated effects in observational studies using routinely collected data: protocol for a cross-sectional study. BMJ Open 2022; 12:e062572. [PMID: 35788067 PMCID: PMC9255408 DOI: 10.1136/bmjopen-2022-062572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Time-varying exposure is an important issue that should be addressed in longitudinal observational studies using routinely collected data (RCD) for drug treatment effects. How well investigators designed, analysed and reported time-varying exposure, and to what extent the divergence that can be observed between different methods used for handling time-varying exposure in these studies remains uncertain. We will conduct a cross-sectional study to comprehensively address this question. METHODS AND ANALYSIS We have developed a comprehensive search strategy to identify all studies exploring drug treatment effects including both effectiveness and safety that used RCD and were published in core journals between 2018 and 2020. We will collect information regarding general study characteristics, data source profile, methods for handling time-varying exposure, results and the interpretation of findings from each eligibility. Paired reviewers will screen and extract data, resolving disagreements through discussion. We will describe the characteristics of included studies, and summarise the method used for handling time-varying exposure in primary analysis and sensitivity analysis. We will also compare the divergence between different approaches for handling time-varying exposure using ratio of risk ratios. ETHICS AND DISSEMINATION No ethical approval is required because the data we will use do not include individual patient data. Findings will be disseminated through peer-reviewed publications.
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Affiliation(s)
- Wen Wang
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Mei Liu
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Jiayue Xu
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Ling Li
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Jing Tan
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Jeff Jianfei Guo
- College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kevin Lu
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Guowei Li
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
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Wiernsperger N, Al-Salameh A, Cariou B, Lalau JD. Protection by metformin against severe Covid-19: an in-depth mechanistic analysis. DIABETES & METABOLISM 2022; 48:101359. [PMID: 35662580 PMCID: PMC9154087 DOI: 10.1016/j.diabet.2022.101359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 12/05/2022]
Abstract
Since the outbreak of Covid-19, several observational studies on diabetes and Covid-19 have reported a favourable association between metformin and Covid-19-related outcomes in patients with type 2 diabetes mellitus (T2DM). This is not surprising since metformin affects many of the pathophysiological mechanisms implicated in SARS-CoV-2 immune response, systemic spread and sequelae. A comparison of the multifactorial pathophysiological mechanisms of Covid-19 progression with metformin's well-known pleiotropic properties suggests that the treatment of patients with this drug might be particularly beneficial. Indeed, metformin could alleviate the cytokine storm, diminish virus entry into cells, protect against microvascular damage as well as prevent secondary fibrosis. Although our in-depth analysis covers many potential metformin mechanisms of action, we want to highlight more particularly its unique microcirculatory protective effects since worsening of Covid-19 disease clearly appears as largely due to severe defects in the structure and functioning of microvessels. Overall, these observations confirm that metformin is a unique, pleiotropic drug that targets many of Covid-19′s pathophysiology processes in a diabetes-independent manner.
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Affiliation(s)
| | - Abdallah Al-Salameh
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France; PériTox/UMR-I 01, University of Picardie Jules Verne, Amiens, France
| | - Bertrand Cariou
- Département d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Hôpital Guillaume et René Laennec, 44093 Nantes Cedex 01, France
| | - Jean-Daniel Lalau
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France; PériTox/UMR-I 01, University of Picardie Jules Verne, Amiens, France.
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Chow E, Yang A, Chung CHL, Chan JCN. A Clinical Perspective of the Multifaceted Mechanism of Metformin in Diabetes, Infections, Cognitive Dysfunction, and Cancer. Pharmaceuticals (Basel) 2022; 15:ph15040442. [PMID: 35455439 PMCID: PMC9030054 DOI: 10.3390/ph15040442] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022] Open
Abstract
In type 2 diabetes, ecological and lifecourse factors may interact with the host microbiota to influence expression of his/her genomes causing perturbation of interconnecting biological pathways with diverse clinical course. Metformin is a plant-based or plant-derived medicinal product used for the treatment of type 2 diabetes for over 60 years and is an essential drug listed by the World Health Organization. By reducing mitochondrial oxidative phosphorylation and adenosine triphosphate (ATP) production, metformin increased AMP (adenosine monophosphate)-activated protein kinase (AMPK) activity and altered cellular redox state with reduced glucagon activity, endogenous glucose production, lipogenesis, and protein synthesis. Metformin modulated immune response by directly reducing neutrophil to lymphocyte ratio and improving the phagocytic function of immune cells. By increasing the relative abundance of mucin-producing and short-chain-fatty-acid-producing gut microbes, metformin further improved the host inflammatory and metabolic milieu. Experimentally, metformin promoted apoptosis and reduced proliferation of cancer cells by reducing their oxygen consumption and modulating the microenvironment. Both clinical and mechanistic studies support the pluripotent effects of metformin on reducing cardiovascular–renal events, infection, cancer, cognitive dysfunction, and all-cause death in type 2 diabetes, making this low-cost medication a fundamental therapy for individualization of other glucose-lowering drugs in type 2 diabetes. Further research into the effects of metformin on cognitive function, infection and cancer, especially in people without diabetes, will provide new insights into the therapeutic value of metformin in our pursuit of prevention and treatment of ageing-related as well as acute and chronic diseases beyond diabetes.
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Affiliation(s)
- Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong 999077, China; (E.C.); (A.Y.); (C.H.L.C.)
- The Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong 999077, China
- Phase 1 Clinical Trial Centre, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong 999077, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong 999077, China; (E.C.); (A.Y.); (C.H.L.C.)
- The Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong 999077, China
| | - Colin H. L. Chung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong 999077, China; (E.C.); (A.Y.); (C.H.L.C.)
| | - Juliana C. N. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong 999077, China; (E.C.); (A.Y.); (C.H.L.C.)
- The Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong 999077, China
- Correspondence: ; Tel.: +852-3505-3138
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Kavazović I, Krapić M, Beumer-Chuwonpad A, Polić B, Turk Wensveen T, Lemmermann NA, van Gisbergen KPJM, Wensveen FM. Hyperglycemia and Not Hyperinsulinemia Mediates Diabetes-Induced Memory CD8 T-Cell Dysfunction. Diabetes 2022; 71:706-721. [PMID: 35044446 DOI: 10.2337/db21-0209] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022]
Abstract
Type 2 diabetes (T2D) causes an increased risk of morbidity and mortality in response to viral infection. T2D is characterized by hyperglycemia and is typically associated with insulin resistance and compensatory hyperinsulinemia. CD8 T cells express the insulin receptor, and previously, we have shown that insulin is able to directly modulate effector CD8 T-cell function. We therefore hypothesized that memory CD8 T-cell responsiveness in the context of T2D is negatively impacted by hyperinsulinemia or hyperglycemia. Using a mouse model for T2D, we could show that memory CD8 T-cell function was significantly reduced in response to rechallenge by viral infection or with melanoma cells. Basal insulin injection of mice increased GLUT-1 expression and glucose uptake in memory CD8 T-cell precursors early after infection, which was prevented when these cells were deficient for the insulin receptor. However, neither insulin injection nor insulin receptor deficiency resulted in a difference in metabolism, memory formation, cytokine production, or recall responses of memory CD8 T cells compared with controls. Importantly, in context of obesity, insulin receptor deficiency on CD8 T cells did not affect the functional capacity of memory CD8 T cells. In contrast, we could show in vitro and in vivo that hyperglycemia significantly impairs the antiviral capacity of memory CD8 T cells. Our findings indicate that obesity impairs the memory CD8 T-cell response against viral infection and cancer through the detrimental effects of hyperglycemia rather than hyperinsulinemia.
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Affiliation(s)
- Inga Kavazović
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mia Krapić
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Ammarina Beumer-Chuwonpad
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Bojan Polić
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tamara Turk Wensveen
- Center for Diabetes, Endocrinology and Cardiometabolism, Thalassotherapia, Opatija, Croatia
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Niels A Lemmermann
- Institute for Virology and Research Center for Immunotherapy (FZI) at the University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Klaas P J M van Gisbergen
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Felix M Wensveen
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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11
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Au PCM, Tan KCB, Cheung BMY, Wong ICK, Wong Y, Cheung CL. Association Between SGLT2 Inhibitors vs DPP-4 Inhibitors and Risk of Pneumonia Among Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2022; 107:e1719-e1726. [PMID: 34748021 DOI: 10.1210/clinem/dgab818] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with diabetes are at a higher risk of pneumonia and pneumonia mortality. Sodium glucose co-transporter 2 inhibitors (SGLT2is), the latest class of glucose-lowering agents, were shown to reduce the risk of pneumonia in clinical trials. However, the real-world effectiveness of SGLT2is on the risk of pneumonia is largely unknown. OBJECTIVE To investigate the associations between SGLT2is use and the risk of pneumonia and pneumonia mortality compared with dipeptidyl peptidase-4 inhibitors (DPP4is) using an electronic medical database in Hong Kong. DESIGN A retrospective cohort study. The "prevalent new-user" design was adopted to account for the previous exposure to the study drugs being compared. Propensity score (PS) matching (1:4) was used to balance the baseline characteristics of the 2 groups. SETTING AND PARTICIPANTS Electronic health data of type 2 diabetes patients using SGLT2is and DPP4is between 2015 and 2018 was collected from the Clinical Data Analysis and Reporting System. MAIN OUTCOME MEASURES Pneumonia incidence and mortality. RESULTS The PS-matched cohort consisted of 6664 users of SGLT2is and 26 656 users of DPP4is, with a mean follow-up of 3.8 years. Poisson regression showed that SGLT2is use was associated with lower risk of pneumonia compared with DPP4is with an absolute rate difference of 4.05 per 1000 person-years (95% CI, 2.61-5.51). The corresponding incidence rate ratio was 0.71 (95% CI, 0.62-0.81). Similar reduction in risk of pneumonia death was observed (hazard ratio 0.57; 95% CI, 0.42-0.77). CONCLUSION Compared with DPP4is, SGLT2is use was associated with a reduced risk of pneumonia and pneumonia mortality in a real-world setting.
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Affiliation(s)
- Philip C M Au
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kathryn C B Tan
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bernard M Y Cheung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Ying Wong
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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12
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Metformin use and the risk of bacterial pneumonia in patients with type 2 diabetes. Sci Rep 2022; 12:3270. [PMID: 35228620 PMCID: PMC8885662 DOI: 10.1038/s41598-022-07294-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/14/2022] [Indexed: 11/08/2022] Open
Abstract
Persons with type 2 diabetes (T2D) have neutrophil dysfunction with a higher risk of infection than those without diabetes. We conducted this study aiming to compare the risk of pneumonia between metformin use and nonuse in persons with T2D. We identified 49,012 propensity score-matched metformin users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. We used the Cox proportional hazards model to compare the risks of pneumonia and respiratory death. The mean (SD) age of the participants was 57.46 (12.88) years, and the mean follow-up time for metformin users and nonusers was 5.47 (3.71) years and 5.15 (3.87) years, respectively. Compared with the nonuse of metformin, the adjusted hazard ratios (95% CI) for metformin use in bacterial pneumonia, invasive mechanical ventilation, and respiratory cause of death were 0.89 (0.84-0.94), 0.77 (0.73-0.82), and 0.64 (0.56-0.74), respectively. A longer cumulative duration of metformin use had further lower adjusted hazard ratios in these risks compared with nonuse. In patients with T2D, metformin use was associated with significantly lower risks of bacterial pneumonia, invasive mechanical ventilation, and respiratory cause of death; moreover, longer metformin use duration was associated with lower hazard ratios of these risks.
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13
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Rim J, Gallini J, Jasien C, Cui X, Phillips L, Trammell A, Sadikot RT. Use of Oral Anti-Diabetic Drugs and Risk of Hospital and Intensive Care Unit Admissions for Infections. Am J Med Sci 2022; 364:53-58. [DOI: 10.1016/j.amjms.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/20/2021] [Accepted: 01/19/2022] [Indexed: 11/01/2022]
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14
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Heo E, Kim E, Jang EJ, Lee CH. The cumulative dose-dependent effects of metformin on the development of tuberculosis in patients newly diagnosed with type 2 diabetes mellitus. BMC Pulm Med 2021; 21:303. [PMID: 34563159 PMCID: PMC8464151 DOI: 10.1186/s12890-021-01667-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). Metformin, which is an essential anti-diabetic drug, has been shown to exhibit anti-TB effects in patients with DM. Its effect on preventing the development of TB among patients who are newly diagnosed with DM remains unclear. METHODS This was a retrospective cohort study using the claims database of the Korean Health Insurance Review and Assessment Service. The study population included patients who were newly diagnosed with type 2 DM and who were treated with anti-diabetic drugs between 1 January 2003 and 31 March 2011. A patient was defined as a metformin user if he/she had taken metformin for more than 28 days within 6 months since cohort entry, and as a metformin non-user if he/she had never been treated with metformin. The development of TB within 2 years after the index date was compared by Cox proportional hazard regression models between metformin users and 1:1 propensity score (PS)-matched non-users. RESULTS Among 76,973 patients who were newly diagnosed with type 2 DM, 13,396 were classified as metformin users, 52,736 were classified as metformin non-users, and 10,841 were excluded from the final analysis. PS-matched Cox proportional hazard regression models revealed that metformin use was not associated overall with the prevention of TB development (HR 1.17; 95% CI 0.75-1.83; P = 0.482). There was a trend, however, towards a reduction in the development of TB among patients taking a higher cumulative dose of metformin. Patients who were in the highest quartile (Q4) of cumulative metformin dose had only a 10% risk of developing TB compared to metformin non-users. In contrast, during the early phases of metformin treatment, patients in the second quartile (Q2) of cumulative metformin use had a higher risk of developing TB than patients in the first quartile (Q1). CONCLUSIONS Only the highest cumulative doses of metformin were protective against the development of TB among patients who were newly diagnosed with type 2 DM; lower cumulative doses of metformin did not appear to reduce the incidence of active TB infection.
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Affiliation(s)
- Eunyoung Heo
- Department of Internal Medicine, SNU-SMG Boramae Medical Center, Seoul, Republic of Korea
| | - Eunyoung Kim
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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15
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Yang A, Shi M, Wu H, Lau ESH, Ma RCW, Kong APS, So WY, Luk AOY, Chan JCN, Chow E. Long-term metformin use and risk of pneumonia and related death in type 2 diabetes: a registry-based cohort study. Diabetologia 2021; 64:1760-1765. [PMID: 33844069 DOI: 10.1007/s00125-021-05452-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS The long-term effects of metformin in individuals with type 2 diabetes who are at increased risk of severe respiratory infections are unknown. This study aimed to evaluate the effects of metformin use on the risk of first pneumonia hospitalisation and pneumonia-related death in a cohort of Chinese individuals with type 2 diabetes. METHODS We performed a retrospective analysis of a consecutive cohort of 22,638 individuals with type 2 diabetes in the Hong Kong Diabetes Register enrolled between 2001 and 2018, with follow-up until 31 December 2019. Overlap propensity-score weighting was performed to balance baseline characteristics. RESULTS Of 22,638 individuals with type 2 diabetes, after excluding those who had not been prescribed any glucose-lowering drugs (GLDs) and/or with eGFR ≤30 ml min-1 [1.73 m]-2 or treated by dialysis and/or treated with insulin at baseline, we identified 15,784 either prevalent or incident metformin users and 917 users of other GLDs during a mean follow-up period of 7.5 years. Overlap-weighted analysis showed an HR of 0.63 (95% CI 0.52, 0.77) for first pneumonia hospitalisation and 0.49 (95% CI 0.33, 0.73) for pneumonia-related death in metformin users vs users of other GLDs; similar observations resulted following stratification by sex and kidney function. There was also a negative association between metformin exposure over time (proportion of duration of metformin prescriptions during the total follow-up time) and pneumonia events using the penalised spline analysis. Metformin users had a lower neutrophil/lymphocyte ratio at first pneumonia hospitalisation vs non-metformin users (mean [95% CI]: 12.8 [12.1, 13.5] vs 14.8 [12.3, 17.3], p = 0.032). The rate of metformin-associated lactic acidosis was 2.5 per 100,000 person-years. The lower risk of pneumonia events was also observed among incident metformin users vs other GLD users. CONCLUSIONS/INTERPRETATION Long-term use of metformin was associated with reduced risk of pneumonia and pneumonia-related death among Chinese individuals with diabetes. The relevance of these results to other respiratory infections merits further investigation.
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Affiliation(s)
- Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Mai Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Wing Yee So
- Hong Kong Hospital Authority Head Office, Kowloon, Hong Kong Special Administrative Region, China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China.
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16
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Masadeh MM, Alzoubi KH, Masadeh MM, Aburashed ZO. Metformin as a Potential Adjuvant Antimicrobial Agent Against Multidrug Resistant Bacteria. Clin Pharmacol 2021; 13:83-90. [PMID: 34007223 PMCID: PMC8123943 DOI: 10.2147/cpaa.s297903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/13/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction The continuous increase in the incidence of bacterial resistance to existing antibiotics represents a worldwide health burden. A surrogate strategy to combat such crisis is to find compounds that restore the antimicrobial activity of the already existing antibiotics against multidrug resistant bacteria. Metformin is a commonly used antidiabetic medication. It has proven benefits in other diseases including cancer, aging-related and infectious diseases. In this study, the potential effect of metformin as an adjuvant therapy to antibiotics was investigated. Methods Two multidrug resistant bacterial strains were used; methicillin-resistant Staphylococcus aureus (MRSA; ATCC 33,591) and multidrug resistant Pseudomonas aeruginosa (ATCC BAA-2114). To assess its efficacy, metformin was combined with several antibiotics: levofloxacin, chloramphenicol, rifampicin, ampicillin, and doxycycline. The antibacterial effect of metformin was tested using the micro broth dilution method. The minimum inhibitory concentration (MIC) was also measured. Cytotoxicity studies were also performed on mammalian cells to assess its safety. Results Metformin exhibited an antibacterial effect when combined with the antibiotics on the two tested strains. It also showed low toxicity on the mammalian cells. Moreover, synergetic studies showed that metformin enhanced the effect of the combined antibiotics, as these combinations provide either a synergistic or additive effect with significant reduction in the MIC. Conclusion Metformin exerts an adjuvant antibacterial effect; thus, it could be a possible candidate as an adjuvant therapy to reduce antimicrobial resistance.
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Affiliation(s)
- Majed M Masadeh
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Majd M Masadeh
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Zainah O Aburashed
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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17
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Narasimhan H, Ren CC, Deshpande S, Sylvia KE. Young at Gut-Turning Back the Clock with the Gut Microbiome. Microorganisms 2021; 9:microorganisms9030555. [PMID: 33800340 PMCID: PMC8001982 DOI: 10.3390/microorganisms9030555] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022] Open
Abstract
Over the past century, we have witnessed an increase in life-expectancy due to public health measures; however, we have also seen an increase in susceptibility to chronic disease and frailty. Microbiome dysfunction may be linked to many of the conditions that increase in prevalence with age, including type 2 diabetes, cardiovascular disease, Alzheimer's disease, and cancer, suggesting the need for further research on these connections. Moreover, because both non-modifiable (e.g., age, sex, genetics) and environmental (e.g., diet, infection) factors can influence the microbiome, there are vast opportunities for the use of interventions related to the microbiome to promote lifespan and healthspan in aging populations. To understand the mechanisms mediating many of the interventions discussed in this review, we also provide an overview of the gut microbiome's relationships with the immune system, aging, and the brain. Importantly, we explore how inflammageing (low-grade chronic inflammation that often develops with age), systemic inflammation, and senescent cells may arise from and relate to the gut microbiome. Furthermore, we explore in detail the complex gut-brain axis and the evidence surrounding how gut dysbiosis may be implicated in several age-associated neurodegenerative diseases. We also examine current research on potential interventions for healthspan and lifespan as they relate to the changes taking place in the microbiome during aging; and we begin to explore how the reduction in senescent cells and senescence-associated secretory phenotype (SASP) interplay with the microbiome during the aging process and highlight avenues for further research in this area.
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Affiliation(s)
| | - Clarissa C. Ren
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | | | - Kristyn E. Sylvia
- The Society for Cardiovascular Angiography and Interventions, Washington, DC 20036, USA
- Correspondence: ; Tel.: +1-774-226-6214
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18
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Chávez-Reyes J, Escárcega-González CE, Chavira-Suárez E, León-Buitimea A, Vázquez-León P, Morones-Ramírez JR, Villalón CM, Quintanar-Stephano A, Marichal-Cancino BA. Susceptibility for Some Infectious Diseases in Patients With Diabetes: The Key Role of Glycemia. Front Public Health 2021; 9:559595. [PMID: 33665182 PMCID: PMC7921169 DOI: 10.3389/fpubh.2021.559595] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023] Open
Abstract
Uncontrolled diabetes results in several metabolic alterations including hyperglycemia. Indeed, several preclinical and clinical studies have suggested that this condition may induce susceptibility and the development of more aggressive infectious diseases, especially those caused by some bacteria (including Chlamydophila pneumoniae, Haemophilus influenzae, and Streptococcus pneumoniae, among others) and viruses [such as coronavirus 2 (CoV2), Influenza A virus, Hepatitis B, etc.]. Although the precise mechanisms that link glycemia to the exacerbated infections remain elusive, hyperglycemia is known to induce a wide array of changes in the immune system activity, including alterations in: (i) the microenvironment of immune cells (e.g., pH, blood viscosity and other biochemical parameters); (ii) the supply of energy to infectious bacteria; (iii) the inflammatory response; and (iv) oxidative stress as a result of bacterial proliferative metabolism. Consistent with this evidence, some bacterial infections are typical (and/or have a worse prognosis) in patients with hypercaloric diets and a stressful lifestyle (conditions that promote hyperglycemic episodes). On this basis, the present review is particularly focused on: (i) the role of diabetes in the development of some bacterial and viral infections by analyzing preclinical and clinical findings; (ii) discussing the possible mechanisms by which hyperglycemia may increase the susceptibility for developing infections; and (iii) further understanding the impact of hyperglycemia on the immune system.
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Affiliation(s)
- Jesús Chávez-Reyes
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Carlos E Escárcega-González
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico.,Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Erika Chavira-Suárez
- Unidad de Vinculación Científica de la Facultad de Medicina, Universidad Nacional Autónoma de México en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Angel León-Buitimea
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico.,Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Priscila Vázquez-León
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - José R Morones-Ramírez
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico.,Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Carlos M Villalón
- Departamento de Farmacobiología, Cinvestav-Coapa, Mexico City, Mexico
| | - Andrés Quintanar-Stephano
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Bruno A Marichal-Cancino
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
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19
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Turk Wensveen T, Gašparini D, Rahelić D, Wensveen FM. Type 2 diabetes and viral infection; cause and effect of disease. Diabetes Res Clin Pract 2021; 172:108637. [PMID: 33352263 PMCID: PMC8050380 DOI: 10.1016/j.diabres.2020.108637] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
The recent pandemic of COVID-19 has made abundantly clear that Type 2 diabetes (T2D) increases the risk of more frequent and more severe viral infections. At the same time, pro-inflammatory cytokines of an anti-viral Type-I profile promote insulin resistance and form a risk factor for development of T2D. What this illustrates is that there is a reciprocal, detrimental interaction between the immune and endocrine system in the context of T2D. Why these two systems would interact at all long remained unclear. Recent findings indicate that transient changes in systemic metabolism are induced by the immune system as a strategy against viral infection. In people with T2D, this system fails, thereby negatively impacting the antiviral immune response. In addition, immune-mediated changes in systemic metabolism upon infection may aggravate glycemic control in T2D. In this review, we will discuss recent literature that sheds more light on how T2D impairs immune responses to viral infection and how virus-induced activation of the immune system increases risk of development of T2D.
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Affiliation(s)
- Tamara Turk Wensveen
- Center for Diabetes, Endocrinology and Cardiometabolism, Thallassotherapia, Opatija, Croatia; Department of Endocrinology, Diabetes and Metabolic Disorders, Clinical Hospital Centre, Rijeka, Croatia; Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Dora Gašparini
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia; School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Felix M Wensveen
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
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20
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Hortová-Kohoutková M, Lázničková P, Frič J. How immune-cell fate and function are determined by metabolic pathway choice: The bioenergetics underlying the immune response. Bioessays 2020; 43:e2000067. [PMID: 33191545 DOI: 10.1002/bies.202000067] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022]
Abstract
Immune cells are highly dynamic in their response to the tissue environment. Most immune cells rapidly change their metabolic profile to obtain sufficient energy to engage in defensive or homeostatic processes. Such "immunometabolism" is governed through intermediate metabolites, and has a vital role in regulating immune-cell function. The underlying metabolic reactions are shaped by the abundance and accessibility of specific nutrients, as well as the overall metabolic status of the host. Here, we discuss how different immune-cell types gain a sufficient energy supply. We then explain how immune cells perform various functions under challenged conditions and expend energy to sustain homeostasis. Finally, we speculate on how the immune-cell metabolic profile might be modulated in health and disease, by manipulating nutrient availability. By such intervention, the recovery of patient with dysregulated immune system responses might be sped up and the fitness of an individual efficiently restored.
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Affiliation(s)
| | - Petra Lázničková
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Frič
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.,Institute of Hematology and Blood Transfusion, Prague, Czech Republic
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21
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Pernicova I, Kelly S, Ajodha S, Sahdev A, Bestwick JP, Gabrovska P, Akanle O, Ajjan R, Kola B, Stadler M, Fraser W, Christ-Crain M, Grossman AB, Pitzalis C, Korbonits M. Metformin to reduce metabolic complications and inflammation in patients on systemic glucocorticoid therapy: a randomised, double-blind, placebo-controlled, proof-of-concept, phase 2 trial. Lancet Diabetes Endocrinol 2020; 8:278-291. [PMID: 32109422 DOI: 10.1016/s2213-8587(20)30021-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND An urgent need to reduce the metabolic side-effects of glucocorticoid overexposure has been recognised, as glucocorticoid excess can lead to Cushing's syndrome, which is associated with high morbidity. We aimed to evaluate the potential of metformin to reverse such effects while sparing the anti-inflammatory benefits of glucocorticoids. METHODS We did a randomised, double-blind, placebo-controlled, proof-of-concept, phase 2 trial involving four hospitals in the UK. Patients without diabetes were eligible if they were between the ages of 18 and 75 years with an inflammatory disease treated with continuous prednisolone (≥20 mg/day for ≥4 weeks and remaining on ≥10 mg/day for the subsequent 12 weeks, or its cumulative dose-equivalent). Eligible patients were randomly allocated (1:1) to either the metformin or placebo groups, using a computer-generated randomisation table stratified according to age and BMI. Metformin and placebo were administered orally for 12 weeks in escalating doses: 850 mg/day for the first 5 days, 850 mg twice a day for the next 5 days, and 850 mg three times a day subsequently. The primary outcome was the between-group difference in visceral-to-subcutaneous fat area ratio over 12 weeks, assessed by CT. Secondary outcomes included changes in metabolic, bone, cardiovascular, and inflammatory parameters over 12 weeks. Our analysis followed a modified intention-to-treat principle for the primary outcome. This study is registered with ClinicalTrials.gov, NCT01319994. FINDINGS Between July 17, 2012, and Jan 14, 2014, 849 patients were assessed for study eligibility, of which 53 were randomly assigned to receive either metformin (n=26) or placebo (n=27) for 12 weeks. 19 patients in the metformin group and 21 in the placebo group were eligible for the primary outcome analysis. Both groups received an equivalent cumulative dose of glucocorticoids (1860 mg prednisolone-equivalent [IQR 1060-2810] in the metformin group vs 1770 mg [1020-2356] in the placebo group); p=0·76). No change in the visceral-to-subcutaneous fat area ratio between the treatment groups was observed (0·11, 95% CI -0·02 to 0·24; p=0·09), but patients in the metformin group lost truncal subcutaneous fat compared with the placebo group (-3835 mm2, 95% CI -6781 to -888; p=0·01). Improvements in markers of carbohydrate, lipid, liver, and bone metabolism were observed in the metformin group compared with the placebo group. Additionally, those in the metformin group had improved fibrinolysis, carotid intima-media thickness, inflammatory parameters, and clinical markers of disease activity. The frequency of pneumonia (one event in the metformin group vs seven in the placebo group; p=0·01), overall rate of moderate-to-severe infections (two vs 11; p=0·001), and all-cause hospital admissions due to adverse events (one vs nine; p=0·001) were lower in the metformin group than in the placebo group. Patients in the metformin group had more events of diarrhoea than the placebo group (18 events vs eight; p=0·01). INTERPRETATION No significant changes in the visceral-to-subcutaneous fat area ratio between the treatment groups were observed; however, metformin administration did improve some of the metabolic profile and clinical outcomes for glucocorticoid-treated patients with inflammatory disease, which warrants further investigation. FUNDING Barts Charity and Merck Serono.
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Affiliation(s)
- Ida Pernicova
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Endocrinology and Metabolic Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Stephen Kelly
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sharon Ajodha
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anju Sahdev
- Department of Radiology, Barts Health NHS Trust, London, UK
| | - Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Plamena Gabrovska
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Ramzi Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Blerina Kola
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marietta Stadler
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Faculty of Life Sciences and Medicine, Department of Diabetes, King's College London, London, UK
| | - William Fraser
- Department of Medicine, University of East Anglia, Norwich, UK
| | - Mirjam Christ-Crain
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital, University of Basel, Basel, Switzerland
| | - Ashley B Grossman
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Costantino Pitzalis
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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22
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Dunachie S, Chamnan P. The double burden of diabetes and global infection in low and middle-income countries. Trans R Soc Trop Med Hyg 2020; 113:56-64. [PMID: 30517697 PMCID: PMC6364794 DOI: 10.1093/trstmh/try124] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022] Open
Abstract
Four out of five people in the world with diabetes now live in low- and middle-income countries (LMIC), and the incidence of diabetes is accelerating in poorer communities. Diabetes increases susceptibility to infection and worsens outcomes for some of the world’s major infectious diseases such as tuberculosis, melioidosis and dengue, but the relationship between diabetes and many neglected tropical diseases is yet to be accurately characterised. There is some evidence that chronic viral infections such as hepatitis B and HIV may predispose to the development of type 2 diabetes by chronic inflammatory and immunometabolic mechanisms. Helminth infections such as schistosomiasis may be protective against the development of diabetes, and this finding opens up new territory for discovery of novel therapeutics for the prevention and treatment of diabetes. A greater understanding of the impact of diabetes on risks and outcomes for infections causing significant diseases in LMIC is essential in order to develop vaccines and therapies for the growing number of people with diabetes at risk of infection, and to prioritise research agendas, public health interventions and policy. This review seeks to give an overview of the current international diabetes burden, the evidence for interactions between diabetes and infection, immune mechanisms for the interaction, and potential interventions to tackle the dual burden of diabetes and infection.
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Affiliation(s)
- Susanna Dunachie
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, 3rd Floor, 60th Anniversary Chalermprakiat Building, 420/6 Ratchawithi Rd., Ratchathewi District, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drie, Headington, Oxford, United Kingdom.,The Peter Medawar Building for Pathogen Research, University of Oxford, South Parks Road, Oxford, United Kingdom
| | - Parinya Chamnan
- Cardiometabolic Research Group, Department of Social Medicine, Sunpasitthiprasong Hospital, Tambon Nai Mueang, Amphoe Mueang Ubon Ratchathani, Chang Wat Ubon Ratchathani, Thailand
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23
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Langan SM, Schmidt SAJ, Wing K, Ehrenstein V, Nicholls SG, Filion KB, Klungel O, Petersen I, Sørensen HT, Dixon WG, Guttmann A, Harron K, Hemkens LG, Moher D, Schneeweiss S, Smeeth L, Sturkenboom M, von Elm E, Wang SV, Benchimol EI. La déclaration RECORD-PE (Reporting of Studies Conducted Using Observational Routinely Collected Health Data Statement for Pharmacoepdemiology) : directives pour la communication des études realisées à partir de données de santé observationelles collectées en routine en pharmacoépidémiologie. CMAJ 2019; 191:E689-E708. [PMID: 31235490 PMCID: PMC6592814 DOI: 10.1503/cmaj.190347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sinéad M Langan
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont.
| | - Sigrún A J Schmidt
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Kevin Wing
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Vera Ehrenstein
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Stuart G Nicholls
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Kristian B Filion
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Olaf Klungel
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Irene Petersen
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Henrik T Sørensen
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - William G Dixon
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Astrid Guttmann
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Katie Harron
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Lars G Hemkens
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - David Moher
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Sebastian Schneeweiss
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Miriam Sturkenboom
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Erik von Elm
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Shirley V Wang
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Eric I Benchimol
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
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Prattichizzo F, Giuliani A, Mensà E, Sabbatinelli J, De Nigris V, Rippo MR, La Sala L, Procopio AD, Olivieri F, Ceriello A. Pleiotropic effects of metformin: Shaping the microbiome to manage type 2 diabetes and postpone ageing. Ageing Res Rev 2018; 48:87-98. [PMID: 30336272 DOI: 10.1016/j.arr.2018.10.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/13/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023]
Abstract
Metformin is the first-choice therapy to lower glycaemia and manage type 2 diabetes. Continuously emerging epidemiological data and experimental models are showing additional protective effects of metformin against a number of age-related diseases (ARDs), e.g., cardiovascular diseases and cancer. This evidence has prompted the design of a specific trial, i.e., the Targeting Aging with Metformin (TAME) trial, to test metformin as an anti-ageing molecule. However, a unifying or prevailing mechanism of action of metformin is still debated. Here, we summarize the epidemiological data linking metformin to ARD prevention. Then, we dissect the deeply studied mechanisms of action explaining its antihyperglycemic effect and the putative mechanisms supporting its anti-ageing properties, focusing on studies using clinically pertinent doses. We hypothesize that the molecular observations obtained in different models with metformin could be indirectly mediated by its effect on gut flora. Novel evidence suggests that metformin reshapes the human microbiota, promoting the growth of beneficial bacterial species and counteracting the expansion of detrimental bacterial species. In turn, this action would influence the balance between pro- and anti-inflammatory circulating factors, thereby promoting glycaemic control and healthy ageing. This framework may reconcile diverse observations, providing information for designing further studies to elucidate the complex interplay between metformin and the metabiome harboured in mammalian body compartments, thereby paving the way for innovative, bacterial-based therapeutics to manage type 2 diabetes and foster a longer healthspan.
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Affiliation(s)
| | - Angelica Giuliani
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
| | - Emanuela Mensà
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
| | - Jacopo Sabbatinelli
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
| | - Valeria De Nigris
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Rita Rippo
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
| | | | - Antonio Domenico Procopio
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy; Center of Clinical Pathology and Innovative Therapy, Italian National Research Centre on Aging, IRCCS INRCA, Ancona, Italy
| | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy; Center of Clinical Pathology and Innovative Therapy, Italian National Research Centre on Aging, IRCCS INRCA, Ancona, Italy
| | - Antonio Ceriello
- IRCCS MultiMedica, Milan, Italy; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
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25
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Wang JL, Dong YH, Ko WC, Chang CH, Wu LC, Chuang LM, Chen PC. Thiazolidinediones and reduced risk of incident bacterial abscess in adults with type 2 diabetes: A population-based cohort study. Diabetes Obes Metab 2018; 20:2811-2820. [PMID: 29974616 DOI: 10.1111/dom.13461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/26/2018] [Accepted: 07/01/2018] [Indexed: 01/01/2023]
Abstract
AIM Previous research has suggested that peroxisome proliferator-activated receptor-gamma (PPAR-γ) may play an important role in immunomodulation. We aimed to examine the association between thiazolidinediones, PPAR-γ agonists and incidence of bacterial abscess among patients with type 2 diabetes. MATERIALS AND METHODS This retrospective cohort study between 2000 and 2010 included 46 986 propensity (PS)-matched patients diagnosed with type 2 diabetes. We compared the incidence of bacterial abscess, including liver and non-liver abscesses, between patients treated with metformin plus a thiazolidinedione (M + T, N = 7831) or metformin plus a sulfonylurea (M + S, N = 39 155). Data were retrieved from a population-based Taiwanese database. We applied Cox proportional hazard regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), comparing M + T and M + S after PS matching. RESULTS During a median follow-up of 4.5 years, the incidence rate of bacterial abscess was lower with M + T than with M + S treatment (1.89 vs 3.15 per 1000 person-years) in the PS-matched cohort. M + T was associated with a reduced risk of bacterial abscess (HRs after PS matching, 0.58; 95% CI, 0.42-0.80 for total bacterial abscess; 0.54; 95% CI, 0.28-1.07 for liver abscess; 0.59; 95% CI, 0.41-0.85 for non-liver abscess). Results did not change materially after accounting for unmeasured confounding factors using high-dimenional PS matching and differential censoring between regimen groups. Rosiglitazone and pioglitazone, in combination with metformin, produced similar reductions in risk of all abscess outcomes. CONCLUSION We found that M + T may provide a protective benefit in reducing the incidence of bacterial abscesses. These findings merit further investigation.
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Affiliation(s)
- Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
| | - Yaa-Hui Dong
- Faculty of Pharmacy, School of Pharmaceutical Science, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
| | - Chia-Hsuin Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Li-Chiu Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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26
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Langan SM, Schmidt SA, Wing K, Ehrenstein V, Nicholls SG, Filion KB, Klungel O, Petersen I, Sorensen HT, Dixon WG, Guttmann A, Harron K, Hemkens LG, Moher D, Schneeweiss S, Smeeth L, Sturkenboom M, von Elm E, Wang SV, Benchimol EI. The reporting of studies conducted using observational routinely collected health data statement for pharmacoepidemiology (RECORD-PE). BMJ 2018; 363:k3532. [PMID: 30429167 PMCID: PMC6234471 DOI: 10.1136/bmj.k3532] [Citation(s) in RCA: 251] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sigrún Aj Schmidt
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Kevin Wing
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Stuart G Nicholls
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kristian B Filion
- Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Irene Petersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Primary Care and Population Health, University College London, London, UK
| | - Henrik T Sorensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Katie Harron
- ICH Population, Policy, and Practice Programme, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center Utrecht, Utrecht, Netherlands
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
| | - Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric I Benchimol
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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27
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Liapikou A, Cilloniz C, Torres A. Drugs that increase the risk of community-acquired pneumonia: a narrative review. Expert Opin Drug Saf 2018; 17:991-1003. [PMID: 30196729 DOI: 10.1080/14740338.2018.1519545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP), a major cause of morbidity and mortality, is the leading infectious cause of death in the developed world. Population-based studies and systematic reviews have identified a large number of risk factors for the development of pneumonia in adults. In addition to age, lifestyle habits, and comorbidities, some forms of pharmacotherapy may also increase the risk for CAP. AREAS COVERED MEDLINE, CENTRAL, and Web of Science were used in 2017 to search for case-control, cohort studies, as well as randomized controlled trials and meta-analysis that involved outpatient proton pump inhibitors (PPIs), inhaled corticosteroids (ICSs), antipsychotics, oral antidiabetics, and CAP diagnosis in patients aged >18 years. EXPERT OPINION Our review confirmed that the use of ICSs, PPIs or antipsychotic drugs was independently associated with an increased risk for CAP. We also identified a positive association between specific oral antidiabetics and the development of pneumonia.
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Affiliation(s)
- Adamantia Liapikou
- a 6th Respiratory Department , Sotiria Chest Diseases Hospital , Athens , Greece
| | - Catia Cilloniz
- b Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , University of Barcelona (UB) - SGR 911 - Ciber de Enfermedades Respiratorias (Ciberes) , Barcelona , Spain
| | - Antoni Torres
- b Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , University of Barcelona (UB) - SGR 911 - Ciber de Enfermedades Respiratorias (Ciberes) , Barcelona , Spain
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28
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Boillat-Blanco N, Tumbo AMN, Perreau M, Amelio P, Ramaiya KL, Mganga M, Schindler C, Gagneux S, Reither K, Probst-Hensch N, Pantaleo G, Daubenberger C, Portevin D. Hyperglycaemia is inversely correlated with live M. bovis BCG-specific CD4 + T cell responses in Tanzanian adults with latent or active tuberculosis. IMMUNITY INFLAMMATION AND DISEASE 2018; 6:345-353. [PMID: 29642283 PMCID: PMC5946156 DOI: 10.1002/iid3.222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/30/2018] [Accepted: 02/26/2018] [Indexed: 01/09/2023]
Abstract
Introduction The rising prevalence of Diabetes mellitus (DM) in high TB‐endemic countries may adversely affect sustainability of TB control since DM constitutes a risk factor for development of active tuberculosis (TB). The impact of DM on TB specific adaptive immune responses remains poorly addressed, particularly in people living in Sub‐Saharan countries. We performed a functional characterization of TB specific cellular immune response in Tanzanian subjects with active or latent Mycobacterium tuberculosis (Mtb) infection stratified by their diabetic status. Methods HIV negative active TB patients (≥18 years) with Xpert MTB/RIF positive pulmonary TB were included before starting TB treatment in Dar es Salaam, Tanzania between April and December 2013. HIV negative healthy controls latently infected with TB but without past TB history were also included. Active and latent TB patients were stratified in two groups according to their diabetic status. Peripheral Blood Mononuclear cells were stimulated with either live M. bovis BCG or Mtb‐specific peptide pools and analyzed by intracellular cytokine staining and polychromatic flow cytometry. Results Our results show a lower frequency of IFN‐γ CD4+ T cells in patients with active TB and DM compared to patients with active TB only after live M. bovis BCG (p = 0.04) but not after Mtb peptide pools re‐stimulation. Irrespective of TB status, level of glycaemia is selectively inversely correlated with IFN‐γ and TNF‐α CD4+ T cell production (p = 0.02 and p = 0.03) after live M. bovis BCG stimulation. Conclusions These results support the hypothesis that hyperglycaemia negatively impacts antigen processing and/or presentation of whole mycobacteria delaying secretion of key cytokines involved in TB immunity.
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Affiliation(s)
- Noémie Boillat-Blanco
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland.,Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Matthieu Perreau
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrizia Amelio
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | - Kaushik L Ramaiya
- Shree Hindu Mandal Hospital and Muhimbili University of Health Sciences, Dar es Salaam, United Republic of Tanzania
| | - Maliwaza Mganga
- Kinondoni Municipal Council, National Tuberculosis Program, Dar es Salaam, United Republic of Tanzania
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Klaus Reither
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Giuseppe Pantaleo
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Damien Portevin
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
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29
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Gorricho J, Garjón J, Alonso A, Celaya MC, Saiz LC, Erviti J, López A. Use of oral antidiabetic agents and risk of community-acquired pneumonia: a nested case-control study. Br J Clin Pharmacol 2017; 83:2034-2044. [PMID: 28294379 DOI: 10.1111/bcp.13288] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 12/15/2022] Open
Abstract
AIMS To evaluate the association between use of different oral antidiabetic agents (OAD) and the risk of community-acquired pneumonia (CAP) in patients with type-2 diabetes (T2DM). METHODS Case-control study nested in a cohort of patients with T2DM and use of OAD between 2002 and 2013, based in a Spanish general practice research database. Cases were people diagnosed with T2DM, aged >18 years and with a validated diagnosis of CAP between 2002 and 2013. Ten controls were matched on age, sex and calendar year. Odds ratio (OR) of CAP was estimated comparing patients treated with: (1) metformin vs. other monotherapies or no antidiabetic treatment; (2) metformin + sulfonylureas vs. other antidiabetic combinations. OR of CAP was also assessed according to antidiabetic treatment duration. RESULTS From a cohort of 76 009 T2DM patients, we identified 1803 cases of CAP. No difference in the incidence of CAP was observed when comparing any OAD in monotherapy with metformin. Compared with current use of metformin + sulfonylurea, thiazolidinediones + metformin was associated with an increased risk of CAP (adjusted OR = 2.48, 95% CI 1.40-4.38). The use of any combination with thiazolidinediones was also associated with higher risk of CAP (adjusted OR = 2.00, 95% CI 1.22-3.28). Current use of DPP-4 inhibitors was not associated with an increased risk of CAP. CONCLUSIONS No differences in the incidence of CAP were observed between the use of OAD in monotherapy vs. metformin. Thiazolidinedione use in combination was associated with an increase in the risk of CAP when compared to metformin + sulfonylureas. The use of DPP-4 inhibitors was not associated with an increased risk of CAP.
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Affiliation(s)
- Javier Gorricho
- Planning, Evaluation and Management Service, General Directorate of Health, Government of Navarre, Calle Irunlarrea 3 (Pabellón Docencia del Hospital de Navarra), 31008, Pamplona, Navarre, Spain
| | - Javier Garjón
- Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain
| | - Alvaro Alonso
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
| | - María Concepción Celaya
- Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain
| | - Juan Erviti
- Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain
| | - Antonio López
- Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain
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30
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Buschard K, Thomassen K, Lynge E, Vejborg I, Tjønneland A, von Euler-Chelpin M, Andersen ZJ. Diabetes, diabetes treatment, and mammographic density in Danish Diet, Cancer, and Health cohort. Cancer Causes Control 2016; 28:13-21. [PMID: 27832382 PMCID: PMC5219016 DOI: 10.1007/s10552-016-0829-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/01/2016] [Indexed: 11/04/2022]
Abstract
Purpose We examined whether diabetes and diabetes treatment are associated with MD in a cohort study of Danish women above age of 50 years. Methods Study cohort consisted of 5,644 women (4,500 postmenopausal) who participated in the Danish Diet, Cancer, and Health cohort (1993–1997) and subsequently attended mammographic screening in Copenhagen (1993–2001). We used MD assessed at the first screening after the cohort entry, defined as mixed/dense or fatty. Diabetes diagnoses and diabetes treatments (diet, insulin, or oral antidiabetic agents) were self-reported at the time of recruitment (1993–1997). The association between MD and diabetes was analyzed by logistic regression adjusted for potential confounders. Effect modification by menopausal status and body mass index (BMI) was performed by introducing an interaction term into the model and tested by Wald test. Results Of 5,644 women with mean age of 56 years, 137 (2.4%) had diabetes and 3,180 (56.3%) had mixed/dense breasts. Having diabetes was significantly inversely associated with having mixed/dense breasts, in both, the crude model (odds ratio; 95% confidence interval: 0.33; 0.23–0.48), and after adjustment for adiposity and other risk factors (0.61; 0.40–0.92). Similar inverse associations were observed for 44 women who controlled diabetes by diet only and did not receive any medication (0.56; 0.27–1.14), and 62 who took oral antidiabetic agents only for diabetes (0.59; 0.32–1.09), while women taking insulin had increased odds of mixed/dense breasts (2.08; 0.68–6.35). There was no effect modification of these associations by menopausal status or BMI. Conclusions Having diabetes controlled by diet or oral antidiabetic agents is associated with a decrease in MD, whereas taking insulin is associated with an increase in MD.
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Affiliation(s)
- Karsten Buschard
- Bartholin Institute, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Katrin Thomassen
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Elsebeth Lynge
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Radiology, Diagnostic Imaging Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen, Denmark
| | - My von Euler-Chelpin
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Zorana Jovanovic Andersen
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
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